Provider Demographics
NPI:1184947947
Name:MOSS-GAIL, DEBORAH ROSE (CRNP)
Entity type:Individual
Prefix:MISS
First Name:DEBORAH
Middle Name:ROSE
Last Name:MOSS-GAIL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2300 W MASTER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-4996
Mailing Address - Country:US
Mailing Address - Phone:215-707-0499
Mailing Address - Fax:215-707-0480
Practice Address - Street 1:2300 W MASTER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-4996
Practice Address - Country:US
Practice Address - Phone:215-707-0499
Practice Address - Fax:215-707-0480
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN574461163W00000X
PASP010535363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse